This revised proposal is submitted in response to PA-02-162 "Long-Term Care Recipients: Quality of Life and Quality of Care Research" co-sponsored by the National Institute on Aging. With this proposal, the Hebrew Rehabilitation Center for Aged, in collaboration with the Massachusetts Department of Public Health, implement and evaluate the efficacy of an intervention to increase the number of high quality nursing homes in Massachusetts. The study involves mounting a three arm intervention in randomly selected nursing homes identified as performing in the aggregate at a poor or at best average level across multiple outcome domains. We call our program "SAVE" - standing for Sustaining Achievable Vitality and Effectiveness. The SAVE program brings together two approaches to care, one utilizing an organizational continuous quality improvement (CQI) system that includes problem recognition, evidence-based care, and evaluation; and the second the implementation of^ecific care protocols targeted at specific outcome areas. The three arms of our intervention include a control group delivering usual care, and two active treatment arms, one implementing the CQI programming (SAVE-CQI), the second implementing the CQI program and the specific protocol programming (SAVE-CQI+). We will sample from Massachusetts nursing homes and accrue to the study 40 that demonstrate adequate data quality but at, in least some of 12 clinical care areas, but have sub-optimal outcomes in these areas. Twenty-four will be assigned randomly to one of the active treatment arms, and 16 to the usual care control condition. We will use MDS data for facility residents of record over a 15-month period to measure changes in presumed quality of care using twelve of the Centers for Medicare and Medicaid Services quality indicators. PUBLIC HEALTH IMPORTANCE: This is an ambitious project, however, the importance of the research is amplified in this era of shrinking public resources and demographic changes resulting increasing numbers of frail, older adults requiring residential long-term care. The intervention itself is relatively low cost, as it will be designed for implementation by a facility's existing staff, and could be implemented in a larger number of facilities using extant resources if the evaluation is favorable.